Abd Elazeem HAS, Saad MM, Ahmed IA, Sayed EG, AlMahdy AM, Atef F, Elassall GM, Ashraf Salah M, Ali AK, Ragab EY, Shazly SA. High-intensity focused ultrasound in management of placenta accreta spectrum: A systematic review.
Int J Gynaecol Obstet 2020;
151:325-332. [PMID:
32976627 DOI:
10.1002/ijgo.13391]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/07/2020] [Accepted: 09/21/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND
High-intensity focused ultrasound (HIFU) is a non-invasive procedure that has been studied in the management of placenta accreta spectrum (PAS).
OBJECTIVE
To appraise HIFU in the management of PAS and highlight the restrictions on converting uterus-preserving studies into evidence-based practice.
SEARCH STRATEGY
A search on Scopus, Cochrane, PubMed and Web of Science was conducted from date of inception to January 2020.
SELECTION CRITERIA
Studies on using HIFU in the management of PAS were eligible. Review articles, conference papers, and case reports were excluded.
DATA COLLECTION
A standardized sheet was used to abstract data from eligible studies. CON-PAS registry was used to include studies on other conservative modalities.
RESULTS
Four studies were eligible (399 patients). Average residual placental volume was 61.74 cm3 (6.01-339 cm3 ). Treatment was successful in all patients. Normal menstruation recovered after 48.8 days (15-150 days). No major complications were encountered. Sixty-one studies were retrieved from the CON-PAS registry; uterine artery embolization (23 studies), balloon placement (15 studies), compression sutures (10 studies), placenta in situ (7 studies), and uterine resection (6 studies) were successful in 83.7%, 92.9%, 87.9%, 85.2%, and 79.3% of cases, respectively.
CONCLUSIONS
HIFU may fit certain clinical situations in the management of PAS. A global research strategy is recommended to incorporate conservative approaches within a comprehensive management protocol.
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